BackgroundAppropriate utilization and compliance of Surgical Safety Checklist reduces occurrence of perioperative surgical complications and improve patient outcomes. However, data on compliance of surgical checklists are scarce in the study area. Therefore, the aim of this study was to evaluate compliance of checklist completion and its barrier for utilization at University of Gondar Hospital, Northwest Ethiopia.MethodsA prospective observational study was conducted among 282 patients undergoing elective and emergency surgery from January to March 2013. Compliance and completeness rate with implementation of Sign-in, Time-out, and Sign-out domains was computed with SPSS 20 package.ResultsA total of 282 operations were performed and checklists were utilized in 39.7 % (112/282) of cases. Among these, most checklists were employed during emergency procedures (61.6 %) that need general anesthesia (75.9 %) in department of surgery (58.9 %). The overall compliance and completeness rate were 39.7 and 63.4 % respectively. The sign-in, time-out and sign-out were missed in 30.5 % (273/896), 35.4 % (436/1,232) and 45.7 % (307/672) respectively. The main reasons cited for non-user were lack of previous training (45.1 %) and lack of cooperation among surgical team members (21.6 %).Conclusions and recommendationsThe completeness rate was satisfactory but the overall compliance rate was suboptimal. An instrument that is used 40 % of the time has been a fairly basic introduction without significant reinforcement training. Moreover, frequent use of the checklist during emergency cases has been deemed to be of value by clinicians. Supplementary training and attention to actual checklist use would be indicated to ensure that this valuable tool could be used more routinely and improve communication. Conducting regular audit of checklist utilization is also recommended.

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Objective:The clinico-pathologic features of urethral stricture in patients with HIV/AIDS are not yet clearly described in the literature. HIV/AIDS has changed the natural course and clinical features of most infectious diseases. We describe some of the features of post-inflammatory strictures associated with HIV Infection and assess the treatment challenges and outcomes of other causes of urethral stricture. Patients and Methods: Consecutive men with urethral stricture who presented to the University Hospital of Gondar, North-West Ethiopia were enrolled. The HIV status, cause of the stricture, type of treatment and outcome were recorded. Results: There were 25 post-traumatic and 15 post-gonococcal urethral strictures. All posttraumatic and 5 of the post-gonococcal urethral stricture patients were HIV negative. All 10 HIV positive patients had longer and denser urethral strictures than expected. The time between gonococcal infection and urethral stricture development was 3-5 years in HIV positive patients. The treatment of post-traumatic stricture included progressive perineal anastomotic urethroplasty and a good outcome was seen in more than 95%. However, the surgical treatment of patients with HIV infection was a challenge. Conclusion: If post-inflammatory urethral stricture occurs in a young man where the time between known gonococcal infection and development of stricture is short (less than 5 years), HIV coinfection is most likely. The stricture in these patients will be longer and denser and not amenable to conventional endoscopic urethrotomy.

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Spontaneous extrusion of bladder stone to perianal area has not been reported so far. We, therefore, report a case and discuss that this may be the natural course of the disease when neglected.